Reactive oxygen species production, induced by atmospheric modification, alter conidial quality of Beauveria bassiana.

AIM: The aim of this study was to determine the relationship between reactive oxygen species (ROS) production and conidial infectivity in Beauveria bassiana. METHODS AND RESULTS: Beauveria bassiana Bb 882.5 was cultured in solid-state culture (SSC) using rice under three oxygen conditions (21%, or pulses at 16 and 26%). Hydrophobicity was determined using exclusion phase assay. Bioassays with larvae or adults of Tenebrio molitor allowed the measurements of infectivity parameters. A fluorometric method was used for ROS quantification (superoxide and total peroxides). NADPH oxidase (NOX) activity was determined by specific inhibition. Conidial hydrophobicity decreased by O2 pulses. Mortality of larvae was only achieved with conidia harvested from cultures under 21% O2 ; whereas for adult insects, the infectivity parameters deteriorated in conidia obtained after pulses at 16 and 26% O2 . At day 7, ROS production increased after 16 and 26% O2 treatments. NOX activity induced ROS production at early stages of the culture. CONCLUSION: Modification of atmospheric oxygen increases ROS production, reducing conidial quality and infectivity. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first study in which conidial infectivity and ROS production in B. bassiana has been related, enhancing the knowledge of the effect of O2 pulses in B. bassiana.

Total parathyroidectomy with presternal intramuscular autotransplantation in renal patients: a prospective study of 66 patients.

Surgical treatment of secondary (SHPT) and tertiary hyperparathyroidism (THPT) may involve various surgical approaches. The aim of this paper was to evaluate presternal intramuscular autotransplantation of parathyroid tissue as a surgical option in SHPT and THPT treatment. 66 patients with renal chronic disease underwent surgery from April 2000 to April 2005 at Universidade Federal São Paulo, Brazil. There were 38 SHPT patients (24 women/14 men), mean age of 39.yrs (range: 14-58), and 28 THPT patients (14 women/14 men), mean age of 43.4 yrs (range: 24-62). Postoperative average followup was 42.9 months (range: 12-96). Postoperative intact PTH increased throughout followup from 73.5 pg/mL to 133 pg/mL on average from 1st to the 5th year, respectively, in SHPT and from 54.9 pg/mL to 94.7 pg/mL on average from 1st to 5th year, respectively, in THPT group. Definitive hypoparathyroidism was observed in 4 (6.06%) patients and graft-dependent recurrence in 6 (9.09%). Presternal intramuscular autotransplantation of parathyroid tissue is a feasible and safe surgical option in SHPT and THPT treatment.

A 10-year experience in intraoperative parathyroid hormone measurements for primary hyperparathyroidism: a prospective study of 91 previous unexplored patients.

Introduction. Primary hyperparathyroidism (PHP) is characteristically determined by high levels of calcium and high or inappropriate levels of parathyroid hormone (PTH). Technological advances have dramatically changed the surgical technique over the years once intraoperative parathyroid hormone (IOPTH) assay had allowed for focused approaches. Objective. To evaluate our 10-year experience in employing a rapid intraoperative PTH assay for PHP. Methods. A prospective cohort of 91 PHP-operated patients in a tertiary institution in São Paulo, Brazil, from June 2000 to April 2011. Results. We had 85 (93.4%) successful parathyroidectomies, 6 (6.6%) failed parathyroidectomies in 91 previous unexplored patients, and 5 (100%) successful remedial surgeries. The IOPTH was true-positive in 88.5%, true-negative in 7.3%, false-positive in 2.1%, and false-negative in 2.1% of the procedures. IOPTH was able to obviate additional exploration or to ask for additional exploration in 92 (95.8%) procedures. Conclusion. The IOPTH revealed to be an important technological adjunct in the current parathyroid surgery for PHP.

The asymmetry index of the cricoid cartilage and the external angle of the thyroid cartilage. A sex-related study

The aim of the study was to assess whether thetransverse diameter is directly proportional,and the anterior-posterior diameter inverselyproportional, to the angle of the thyroid cartilage,thus determining the degree of asymmetryin relation to age and sex, by comparingspecimens of larynxes. Analyses were performedon specimens of larynxes from cadavers: 50 male and 50 female. The age rangevaried from 40 to 98 years, with an average of58.68. Macroscopic analysis for the presence oflesions was performed with the aid of a magnifyingglass. A goniometer (Carci®) was used to obtain the angle of aperture of the two laminas of the thyroid cartilage. The internal dimensions of the cricoid cartilage were obtained using a digital pachymeter (Starrett®Tolls). The asymmetry index of the anteroposterior and transverse measurements of thecricoid cartilage was obtained for both sexgroups.The correlation between the angle of the thyroid cartilage and degree of asymmetry of the cricoid cartilage was insignificant in both males (r=0.027; p=0.426) and females (r=0.010; p=0.472). These findings suggest that there is no relationship between the angleof the thyroid cartilage and the degree of asymmetry of the cricoid cartilage. However, a significant difference was observed between the sexes in the transverse and antero-posterior diameters of the cricoid cartilage. Contrary to expectations, the findings failed to show the suggested relationship between the asymmetry index of the internal diameters of the cricoid cartilage and the external angle of the thyroid cartilage (AU)

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Analysis of the diagnostic presentation profile, parathyroidectomy indication and bone mineral density follow-up of Brazilian patients with primary hyperparathyroidism.

Primary hyperparathyroidism is an endocrine disorder with variable clinical expression, frequently presenting as asymptomatic hypercalcemia in Western countries but still predominantly as a symptomatic disease in developing countries. The objective of this retrospective study was to describe the diagnostic presentation profile, parathyroidectomy indication and post-surgical bone mineral density follow-up of patients with primary hyperparathyroidism seen at a university hospital. We found 115 patients (92 women, median age 56 years) with primary hyperparathyroidism diagnosed during the last 20 years. We defined symptomatic patients based on the presence of any classical symptom affecting bone, kidney or the neuromuscular system. Surgical criteria followed the guidelines of the National Institutes of Health regarding asymptomatic primary hyperparathyroidism. Symptomatic patients and patients meeting surgical criteria for parathyroidectomy were 66 and 93% of the sample, respectively. Median calcium and parathyroid hormone values were 11.9 mg/dL and 189 pg/mL, respectively. After surgical treatment, 97% of patients were cured, with increases in bone mineral density of 19.4% in the lumbar spine and 15.7% in the femoral neck 3 years after surgery. Greater bone mass increases were detected in pre-menopausal women, men, and in symptomatic and younger patients, both in the lumbar spine and femoral neck. Our results support the previous findings of a predominantly symptomatic disease with a presentation profile that could be mainly related to a delayed diagnosis. Nevertheless, genetic and racial backgrounds, and nutritional factors such as calcium and vitamin D deficiency may play a role in the clinical presentation of primary hyperparathyroidism of Brazilian patients.

Analysis of the diagnostic presentation profile, parathyroidectomy indication and bone mineral density follow-up of Brazilian patients with primary hyperparathyroidism

Primary hyperparathyroidism is an endocrine disorder with variable clinical expression, frequently presenting as asymptomatic hypercalcemia in Western countries but still predominantly as a symptomatic disease in developing countries. The objective of this retrospective study was to describe the diagnostic presentation profile, parathyroidectomy indication and post-surgical bone mineral density follow-up of patients with primary hyperparathyroidism seen at a university hospital. We found 115 patients (92 women, median age 56 years) with primary hyperparathyroidism diagnosed during the last 20 years. We defined symptomatic patients based on the presence of any classical symptom affecting bone, kidney or the neuromuscular system. Surgical criteria followed the guidelines of the National Institutes of Health regarding asymptomatic primary hyperparathyroidism. Symptomatic patients and patients meeting surgical criteria for parathyroidectomy were 66 and 93 percent of the sample, respectively. Median calcium and parathyroid hormone values were 11.9 mg/dL and 189 pg/mL, respectively. After surgical treatment, 97 percent of patients were cured, with increases in bone mineral density of 19.4 percent in the lumbar spine and 15.7 percent in the femoral neck 3 years after surgery. Greater bone mass increases were detected in pre-menopausal women, men, and in symptomatic and younger patients, both in the lumbar spine and femoral neck. Our results support the previous findings of a predominantly symptomatic disease with a presentation profile that could be mainly related to a delayed diagnosis. Nevertheless, genetic and racial backgrounds, and nutritional factors such as calcium and vitamin D deficiency may play a role in the clinical presentation of primary hyperparathyroidism of Brazilian patients.

Changes in clinical and laboratory findings at the time of diagnosis of primary hyperparathyroidism in a University Hospital in São Paulo from 1985 to 2002.

In contrast to most developed countries, most patients with primary hyperparathyroidism in Brazil are still symptomatic at diagnosis. However, we have been observing a change in this pattern, especially in the last few years. We evaluated 104 patients, 77 females and 27 males aged 11-79 years (mean: 54.4 years), diagnosed between 1985 and 2002 at a University Hospital. Diagnosis was made on the basis of clinical findings and of high total and/or ionized calcium levels, high or inappropriate levels of intact parathyroid hormone and of surgical findings in 80 patients. Patients were divided into three groups, i.e., patients diagnosed from 1985 to 1989, patients diagnosed from 1990 to 1994, and patients diagnosed from 1995 to 2002. The number of new cases diagnosed/year increased from 1.8/year in the first group to 6.0/year in the second group and 8.1/year in the third group. The first group comprised 9 patients (mean serum calcium +/- SD, 13.6 +/- 1.6 mg/dl), 8 of them (88.8%) defined as symptomatic. The second group comprised 30 patients (mean calcium +/- SD, 12.2 +/- 1.63 mg/dl), 22 of them defined as symptomatic (73.3%). The third group contained 65 patients (mean calcium 11.7 +/- 1.1 mg/dl), 34 of them symptomatic (52.3%). Patients from the first group tended to be younger (mean +/- SD, 43.0 +/- 15 vs 55.1 +/- 14.4 and 55.7 +/- 17.3 years, respectively) and their mean serum calcium was significantly higher (P < 0.05). All of symptomatic patients independent of group had higher serum calcium levels (12.4 +/- 1.53 mg/dl, N = 64) than asymptomatic patients (11.4 +/- 1.0 mg/dl, N = 40). Our data showed an increase in the percentage of asymptomatic patients over the years in the number of primary hyperparathyroidism cases diagnosed. This finding may be due to an increased availability of diagnostic methods and/or to an increased awareness about the disease.

Changes in clinical and laboratory findings at the time of diagnosis of primary hyperparathyroidism in a University Hospital in São Paulo from 1985 to 2002

In contrast to most developed countries, most patients with primary hyperparathyroidism in Brazil are still symptomatic at diagnosis. However, we have been observing a change in this pattern, especially in the last few years. We evaluated 104 patients, 77 females and 27 males aged 11-79 years (mean: 54.4 years), diagnosed between 1985 and 2002 at a University Hospital. Diagnosis was made on the basis of clinical findings and of high total and/or ionized calcium levels, high or inappropriate levels of intact parathyroid hormone and of surgical findings in 80 patients. Patients were divided into three groups, i.e., patients diagnosed from 1985 to 1989, patients diagnosed from 1990 to 1994, and patients diagnosed from 1995 to 2002. The number of new cases diagnosed/year increased from 1.8/year in the first group to 6.0/year in the second group and 8.1/year in the third group. The first group comprised 9 patients (mean serum calcium ± SD, 13.6 ± 1.6 mg/dl), 8 of them (88.8 percent) defined as symptomatic. The second group comprised 30 patients (mean calcium ± SD, 12.2 ± 1.63 mg/dl), 22 of them defined as symptomatic (73.3 percent). The third group contained 65 patients (mean calcium 11.7 ± 1.1 mg/dl), 34 of them symptomatic (52.3 percent). Patients from the first group tended to be younger (mean ± SD, 43.0 ± 15 vs 55.1 ± 14.4 and 55.7 ± 17.3 years, respectively) and their mean serum calcium was significantly higher (P < 0.05). All of symptomatic patients independent of group had higher serum calcium levels (12.4 ± 1.53 mg/dl, N = 64) than asymptomatic patients (11.4 ± 1.0 mg/dl, N = 40). Our data showed an increase in the percentage of asymptomatic patients over the years in the number of primary hyperparathyroidism cases diagnosed. This finding may be due to an increased availability of diagnostic methods and/or to an increased awareness about the disease.

Usefulness of a rapid immunometric assay for intraoperative parathyroid hormone measurements.

Intraoperative parathyroid hormone (IO-PTH) measurements have been proposed to improve operative success rates in primary, secondary and tertiary hyperparathyroidism (PHP, SHP and THP). Thirty-one patients requiring parathyroidectomy were evaluated retrospectively from June 2000 to January 2002. Sixteen had PHP, 7 SHP and 8 THP. Serum samples were taken at times 0 (before resection), 10, 20 and 30 min after resection of each abnormal parathyroid gland. Samples from 28 patients were frozen at -70 C for subsequent tests, whereas samples from three patients were tested while surgery was being performed. IO-PTH was measured using the Elecsys immunochemiluminometric assay (Roche, Mannheim, Germany). The time necessary to perform the assay was 9 min. All samples had a second measurement taken by a conventional immunofluorimetric method. We considered as cured patients who presented normocalcemia in PHP and THP, and normal levels of PTH in SHP one month after surgery and who remained in this condition throughout the follow-up of 1 to 20 months. When rapid PTH assay was compared with a routine immunofluorimetric assay, excellent correlation was observed (r = 0.959, P < 0.0001). IO-PTH measurement showed a rapid average decline of 78.8% in PTH 10 min after adenoma resection in PHP and all patients were cured. SHP patients had an average IO-PTH decrease of 89% 30 min after total parathyroidectomy and cure was observed in 85.7%. THP showed an average IO-PTH decrease of 91.9%, and cure was obtained in 87.5% of patients. IO-PTH can be a useful tool that might improve the rate of successful treatment of PHP, SHP and THP.

Usefulness of a rapid immunometric assay for intraoperative parathyroid hormone measurements

Intraoperative parathyroid hormone (IO-PTH) measurements have been proposed to improve operative success rates in primary, secondary and tertiary hyperparathyroidism (PHP, SHP and THP). Thirty-one patients requiring parathyroidectomy were evaluated retrospectively from June 2000 to January 2002. Sixteen had PHP, 7 SHP and 8 THP. Serum samples were taken at times 0 (before resection), 10, 20 and 30 min after resection of each abnormal parathyroid gland. Samples from 28 patients were frozen at -70ºC for subsequent tests, whereas samples from three patients were tested while surgery was being performed. IO-PTH was measured using the Elecsys immunochemiluminometric assay (Roche, Mannheim, Germany). The time necessary to perform the assay was 9 min. All samples had a second measurement taken by a conventional immunofluorimetric method. We considered as cured patients who presented normocalcemia in PHP and THP, and normal levels of PTH in SHP one month after surgery and who remained in this condition throughout the follow-up of 1 to 20 months. When rapid PTH assay was compared with a routine immunofluorimetric assay, excellent correlation was observed (r = 0.959, P < 0.0001). IO-PTH measurement showed a rapid average decline of 78.8 percent in PTH 10 min after adenoma resection in PHP and all patients were cured. SHP patients had an average IO-PTH decrease of 89 percent 30 min after total parathyroidectomy and cure was observed in 85.7 percent. THP showed an average IO-PTH decrease of 91.9 percent, and cure was obtained in 87.5 percent of patients. IO-PTH can be a useful tool that might improve the rate of successful treatment of PHP, SHP and THP

Circadian rhythms of occipital-cortex temperature and motor activity in young and old rats under chronic protein malnutrition.

The circadian rhythm of cortical temperature registered in the right occipital cortex and the circadian rhythm of motor activity were studied in young and old rats submitted to a chronic malnutrition paradigm. Circadian rhythms of cortical temperature and motor activity in Control (25% casein) and Malnourished (6% casein) Sprague-Dawley male rats were registered by telemetry along different lighting conditions. Results indicate that: (1) there are masking effects of light upon the period of cortical temperature in malnourished-old rats, (2) cortical temperature and motor-activity rhythms, show endogenous periods different from 24-h under free-running conditions, (3) protein malnutrition increases the amplitude and the mean value of cortical-temperature rhythm in malnourished-young rats, (4) aging decreases the amplitude and mean value of the motor-activity rhythm, (5) the acrophase of cortical temperature is delayed in malnourished-old rats, and (6) the temporal relationship between cortical temperature and motor-activity circadian rhythms is altered in malnourished-young and old rats. Therefore, this study provides evidence that protein malnutrition produces long-lasting alterations in the architecture of the circadian system, particularly affecting cortical-temperature oscillation. These changes might indicate thermoregulatory differences in the brain of malnourished rats that could be related to metabolic and behavioral alterations due to protein malnutrition.

Pre- and post-natal protein malnutrition alters the effect of rapid eye movements sleep-deprivation by the platform-technique upon the electrocorticogram of the circadian sleep-wake cycle and its frequency bands in the rat.

Selective deprivation of paradoxical (or rapid eye movements) sleep (REMS) in protein malnourished young male rats, results in circadian and homeostatic alterations. By means of electrocorticographic recordings, we have examined the sleep-wake cycle as a functional maturity index, and its circadian and homeostatic mechanisms in prenatal (PM) and chronically (CM) protein malnourished young male rats. The effects of rapid eye movements sleep-deprivation (REMS-D), by the platform technique in a "conflict experiment" (i.e. recovery from REMS-D begun during the circadian phase of activity), revealed that in PM animals, wake (WAK) was increased significantly during recovery days 1 and 2 (RD1, RD2); and slow wave sleep (SWS) was reduced significantly during these days. Prenatal protein-malnutrition altered the phase of WAK and REMS rhythms, and the amplitude of SWS rhythm was decreased. The REMS compensatory increase after REMS-D (REMS rebound) was confined to the first 4-h block of the activity phase in all experimental groups and 24 h later another REMS rebound was displayed in PM animals. The paradoxical sleep-rebound in CM animals was significantly higher than control and PM rats and it was only shown at the first 4-h block after REMS-D. Before and after REMS-D the circadian distribution of both sleep states, and the electrocortical frequency bands showed different circadian phases at the same day-time in control, PM and CM rats. The aforementioned indicates that protein malnutrition exerts important effects on the circadian and homeostatic mechanisms driving sleep. Therefore, the temporal structure of the malnourished rats may not allow proper synchronization of some sleep parameters, particularly REMS, to the environmental time cues.

Síndrome de Frey / Frey's syndrome

É apresentada uma revisäo sobre sudorese gustatória (síndrome de Frey) após cirurgias sobre a glândula parótida. O histórico, a fisiopatologia, o diagnóstico, incluindo uma nova modalidade terapêutica usando toxina botulínica, säo abrangentemente discutidos.

Frontal sinus adenocarcinoma.

CONTEXT: Paranasal sinus cancer is considered rare, with an incidence of less than 1 per 100,000 per year, with the frontal sinus being the primary site in only 0.3%. We report a case of adenocarcinoma arising in the frontal sinus. DESIGN: Case report. CASE REPORT: A 59-year-old woman, secretary, came in February 1998 with a 4-month history of low intensity frontal headache. She denied contact with wood dust. On examination a non-tender swelling was noted over her right forehead next to the medial aspect of the right orbit. CT scan showed a soft-tissue mass involving frontal sinus with intracranial invasion through the posterior wall. The anterior ethmoid sinus and the medial aspect of the right orbit were also involved. MRI demonstrated dural thickening in communication with the frontal mass. She underwent an en-bloc tumor resection by craniotomy including orbital clearance. Histology revealed an adenocarcinoma. After surgery she had tumor recurrence, and chemotherapy and radiotherapy were started resulting in partial improvement.

Clinical management of six cases of low-risk primary tonsillar non-Hodgkin's lymphoma.

CONTEXT: There have been many reports that favor aggressive systemic treatment with chemotherapy and radiotherapy, even for well-localized lymphomas, avoiding the need for tonsillectomy of the normal tonsil. CASE REPORT: We report six cases of primary tonsillar lymphoma with a median patient age of 42 years. There were two lymphoma cases with diffuse large cells, two cases with mixed small and large cells, one with small cells and one indeterminate. They were treated with six cycles of chemotherapy and cervical radiotherapy. All patients achieved durable complete remission. Our data agree with previous reports that suggested that primary tonsillar high-grade B-cell NHL has a good prognosis if aggressively treated.

Rhythmic changes in the serotonin content of the brain and eyestalk of crayfish during development

The present study investigated developmental circadian changes in the content of 5-hydroxytryptamine (5-HT) in two structures proposed to contain pacemakers in crayfish Procambarus clarkii: the cerebral ganglion and the eyestalks. Crayfish (N=260) from three developmental stages were divided into two groups: (1) animals subjected to 12 h:12 h light:dark cycles for 10 days and (2) animals treated as described above, then exposed to 72 h of continuous dim light. Crayfish from both groups were killed at different times of day, and the cerebral ganglion and the eyestalks of each were assayed for 5-HT by reversed-phase HPLC with electrochemical detection. In all stages of development, 5-HT content (expressed as (&mgr;)g g(-)(1 )wet mass tissue) showed circadian variations in both structures analyzed; rhythms continued to free-run under constant illumination, and total 5-HT content was higher in the brain (0.581+/-0.36 (&mgr;)g g(-)(1); mean +/- s.e.m.) than in the eyestalks (0.299+/-0.15 (&mgr;)g g(-)(1)). As development advances, the percentage of the rhythm that shows periods of 24 h diminishes, while the percentage of the rhythm that shows periods of 9 to 12 h increases. This seems to indicate that pulsatile variations in 5-HT content are superimposed in a circadian component. The relationship between the 5-HT rhythm and electroretinogram and motor activity rhythms during development is discussed.

Granuloma letal da linha média: abordagem clínica e terapêutica de três casos / Lethal midline granuloma: clinical management of three cases

Objetivo. Relato de três casos do GLLM acompanhados pela Disciplina de Hematologia e Hemoterapia da Unifesp-EPM que tiveram boa resposta à terapêutica e evoluçao favorável. Métodos. Após confirmaçao histológica e histoquímica, os pacientes foram submetidos à tratamento quimio e radioterápico com boa resposta terapêutica. Resultados. Atualmente estes pacientes encontram-se em remissao total da doença, com sobrevida média de 45 meses. Conclusao. Levando-se em consideraçao nossa pequena experiência, acreditamos que o tratamento radioterápico e a abordagem quimioterápica inicial agressiva sao fundamentais para uma boa evoluçao deste tipo de linfoma.